Psychotherapy's Greatest Debates - Page 7

JOHNSON: I’d come at this kind of situation differently than Terry. If you want somebody to explore their experience and grow, it seems to me that first you have to help them feel safe. Of course, sometimes people will tolerate confrontation whether they are safe or not, but lots of times, they won’t. They run from you, or they’ll defend and eventually leave. What strikes me about Terry’s story is that this man had a new, corrective, emotional experience. There’s a sense in which you can show people empathy, but in my experience, you can’t directly teach it. People have to feel it. You can’t teach somebody to be tender or to have sexual desire or to have compassion. It has to be a real felt sense.

So in EFT, we place a lot of emphasis on reflective processing. For example, imagine a man who, after many years of doing just the reverse, starts to express his feelings. When that happens, you hope that his wife is going to be accepting and loving. But what often happens instead is that the wife will say, “Well, what took you so long, buddy?” And then she clocks him by saying something nasty, right?

In that situation, what I’d do is confront by saying, “Could we just stop a minute, please?” Although, at one level, EFT is warm and cuddly, it can also be directive. I’d take the time to reflect the process, and say, “What just happened for you? Your husband turned to you and said, ‘You’re right, I do shut down and move away because I get so scared, and could you help me?’ You turned your body away, got an angry expression, and then turned back to him and said, ‘Oh, right! Now we’re all supposed to feel sorry for poor Larry.’” She looks at me, so I replay it. Then I say, “What happens for you when you hear him say this?” I give her the cue again, and I stay with her. You’re not blaming her for not hearing him; she’s going to get angry with you if you do that. You’re not blaming her. You’re saying, “Could you help me? There’s something about this that’s hard for you to hear. He’s opening up to you right now, but you can’t hear him. It’s hard for you to hear. Is that right?”

So she looks at me and says, “Yes, I can’t hear. I’m too angry.”

I say, “I understand.”

As I say understand, her eyes fill with tears. She turns to her husband and says, “Now . . . now you tell me your feelings, when I’ve hurt for so long? When you’ve shut me out for so long? Some part of me just wants you to . . . I don’t know what.”

I say, “You want him to hurt.”

She says, “Yes.”

I say, “OK, so can you tell him? ‘I’ve hurt for so long, part of me wants to hear you, but some part of me wants you to hurt, too.’” And she does this.

Well, that’s a shift. But it’s a shift that works with her feelings. It’s not a shift from my saying, “Now, do you see that slamming him doesn’t really work if you want your husband to become more open with you?” For me, that doesn’t work. It’s too top-down. She’s just going to fight me. I want her to look at how hard it is for her—even when her husband reaches for her now—to respond emotionally. That’s also confrontation, but a process-oriented, reflective confrontation, that’s done in a way that the person still feels that you’re with them.

REAL: I’m 100 percent with Sue on that last point. When you confront a client, you must do it in a way that leaves them feeling like you’re on their side. In what Sue just described, she addresses a part of this woman that wanted to hurt her husband. In the way I work, I talk about differentiating between the person and their dysfunctional behaviors, or their dysfunctional ways of thinking. One of the things I say at the end of many first sessions when I’m dealing with a grandiose person is something like this: “You’re warm, you’re funny, you take in what I have to say, and yet you’ve been having multiple affairs throughout this marriage. What’s sad about this is that I’m dealing with a decent person who’s been behaving indecently for the last 20 years. Let me help you extricate the decent person that you truly are from all of this crazy behavior.”

The way Sue would deal with a woman who clobbers her husband when he finally shares with her sounds effective, but I have a slightly different way of going about it. I might say, “Listen, what’s going on here is you’ve asked for his feelings, he gives you his feelings, and then you clobber him. Do you think that’s going to work?” And then it moves into where that comes from. I think my version—or the analog to Sue’s moving into feeling—is I’m moving into the family of origin. I’d speak to her about what I call the “marital wound.” I’d normalize it. I’d say, “I know you’ve been hoping to get this out of your husband for 20 years. You’ve been vulnerable over and over again, and been disappointed. Of course, you don’t want to be vulnerable now. I understand that. Yet, for this to work, you’re going to have to find the resources to do that.” So it’s more teacherly. It’s both more telling the truth to the person about what they’re doing that’s blowing their own foot off and, beyond that, investigating where that behavior comes from in their history. I also want to be sure to suggest new moves they might try.

Unlike Sue, I don’t believe that the people who come to us always have the solution inside themselves and what we need to do is just help them find it. I believe that the people who come to us have what I call “relational deformities” that they learn in their family of origin. The son of a rager is a rager, and the reason why he’s a rager is because he grew up with a rager, and he thinks raging at things is OK. So I talk about how that behavior is getting in the person’s way and where it comes from. I try to move that person from being comfortable with his own behavior to feeling bad about it—in a healthy way—if it’s dysfunctional or destructive. I talk about bringing someone out of shamelessness into healthy shame. It’s at that point that you teach them what being more vulnerable in a situation might look like. I do what Sue called top-down. You can shoot me, but I think it works.

JOHNSON: The tricky part about shame is deciding whether it’s healthy or not. But the trouble with shame is that the actual tendency behind shame, if you look at the structure of the emotion, is to hide and withdraw. So it’s a pretty tricky to decide when to shame somebody. If you’re saying to somebody, “Do you understand the impact you have on your partner?” I don’t think that has to be shaming. I mean, I agree with Terry that most of us learn these basic ways of being in our family of origin. The man who constantly shuts down and stays very still as his wife gets upset with him probably grew up in a violent family in which the only way not to be abused was to basically disappear into the wallpaper. You can say that it’s a choice, but it’s a default option that was laid down in his brain at a early age, and when he’s panicked—and I’m using the word literally, because all the neuroscience on attachment says that’s exactly how you feel when you can’t connect with your partner—he goes into withdrawal and is no longer cognitively available to see the impact on his partner. As Terry says, he can’t comprehend how he’s shooting himself in the foot. You’re going to have to give him an experience in the session of talking about his terrified withdrawal or putting into the words the feeling that “There’s something fundamentally wrong with me: I’m completely flawed.” Anything that adds more shame on top of that is going to make it that much harder to reach this guy.

But when this kind of man finally starts to be able to tell his wife about his deep fear that nobody could possibly love him, you can see him, literally, grow in the session, because he starts to understand that his emotions are workable—that he can actually talk about them. You can ask him, “Can you feel this right now?” And he says, “Yes, I feel it right now. I can’t look in her face because I’m afraid I’m going to see this terrible disapproval.” Then I encourage him. I ask him to look at my face, and then to look at his wife’s face, and then he sees that she’s full of love and caring for him. Then he says, “I’m so scared to really show you who I am.” She then leans across and she puts her hand on his knee.

That man’s just had a corrective emotional experience of a part of himself that was filled with shame, and he’s now able to be out in the world with his wife and feel her tenderness. That’s how people grow together in a good marriage. The wonderful thing about marriage is that it’s a second chance to really be in a new dance with a new person, deal with those childhood emotions differently, and get much more positive feedback. So we go there, rather than using shame in the way Terry is talking about.

REAL: One of the things we say in RLT [Relational Life Therapy] is that if you change the affect, you’ll change the stance. So we’re right in line on that. One of the differences, though, is that we’d actually teach somebody how to do it. For example, when we’re teaching somebody how to give feedback to somebody, we coach them to skip over their first feeling—their most accustomed feeling—and see if they can move to an unaccustomed feeling. So if you’re used to leading with small, vulnerable, helpless, desperate feelings, we want you to get in touch with your power and anger. If you’re used to being big and angry, we want you to get in touch with your hurt and vulnerability. But I also think you can lead with a cognitive shift, and it can have a lot of emotion with it. The other thing I want to say is the therapy isn’t shaming. The goal is to help somebody move from being shameless to healthy or appropriate shame. We don’t shame our patients: we teach them how to be better. I had a case in which the woman was a rager who screamed at her husband in front of her kids.

In one session, I said to her, “You have to stop doing this.” She said, as most ragers do, “It comes upon me too quickly. I can’t.”

Then I made a strategic move. I said, “OK, here’s what I want you to do. Do you have pictures of your kids?” Yes, they were beautiful kids. “OK, you have my permission to rage at your husband in front of your kids. But before you do that, I want you to look at some family photos of your kids and look into their eyes and say, ‘I know what I’m about to do is going to cause you deep and permanent harm, but right now, my anger is more important to me than you are, so screw you.’” I put my arm around her shoulder, and said, “Let’s practice that, shall we? Hold up the pictures, and ‘I know . . .’”

She burst into tears and said, “I can’t say that to my children.”

I said, “No, my dear, but you are saying that to your children. You’re saying that every time you scream at their father in front of them. All I want you to do is say it out loud and own it.”

Then she said, “I’ll never rage at my husband again for the rest of my life.”

I’m here to tell you—that was 17 years ago, and from that moment forward, she stopped that behavior. That’s what I talk about as bringing somebody from shamelessness into healthy shame. This woman had grown up with a lot of rage, and it simply didn’t occur to her that if you get pissed off at somebody, you don’t get to rip their head off. That thought wasn’t in her repertoire until she came into therapy. I think it’s a disservice to take somebody like that and not actively give them the tools they need to move beyond it.

JOHNSON: I agree that you have to help clients contain certain negative behaviors, but we might do it in a different way. In this case, an EFT therapist would stop and then reflect the process. “You’re caught in that rage, right? And that rage pushes your husband away from you and leaves you all alone. But you’re caught in that rage. Let’s listen to the rage.”

If you listen, and you press the elevator and go beneath the rage, what you hear is desperation. What you hear is helplessness. What you hear usually, when someone is raging at their partner is, “I’ll make you listen to me. You must listen to me. If I can’t impact you, there’s no relationship. I don’t matter to anybody.” That puts people into a complete funk.

So yeah, you’d show her. You’d unpack that rage in the session, because it’s what we’d call a secondary emotion. You’d go down to the primary emotion, which is “If I don’t yell, you’ll never listen to me. If I don’t yell, I’m all by myself.” We’d also validate this woman. “When you were a child, the only thing you ever saw was yelling, so that’s what you do. But right here, right now, it’s pushing your husband away.”

Q: As I hear the two of you describe your approaches, I’m struck by how much, in addition to your theories, your actual work is shaped by your personalities and your gender. What do each of you see as your primary role in the process of change?

JOHNSON: EFT is based on Attachment Theory and the science of bonding relationships. Guided by that, much of what I do as a therapist is based on my belief that my role is to be a surrogate attachment figure who doesn’t allow their kid to act out in front of them, but directs them gently, and helps them explore and move and grow. Part of that may have to do with my personality, but I think it’s more than that. It’s a particular way of seeing problems, and a particular way of being with people.

Q: Are we coming down to a classic distinction between the different ways that men and women look at relationship? Terry, are you a surrogate attachment figure or, in the time-honored male tradition, a bit more of a coach?

REAL: Well, if I’m an attachment figure, it’s a paternal rather than a maternal one. But I think my job is to coach the two partners to have a corrective emotional experience with each other. I’m much more like a 12-Step counselor, or, if you prefer, a coach.